Facelifts – Scarring and Tension Around the Ears (Pixie Ear) – How to Avoid, Treat, and Revise

Thank you for your question. You’ve submitted
several photos and you state that now you are eight months after facelift. And you’re
describing two situations involving these – the incisions in the areas around the
ears. One is the right ear, there’s a pulling of fat on the ear. And the left ear, you have
some numbness; as well as the concern about the scars, the incision lines being very red
and itchy. Well I can give you some guidance based on
how we manage patients like yourself in our practice. To begin with, just a little background.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic surgeon
practicing in Manhattan and Long Island for over 20 years. Face lifting surgery is a big
part of my practice and I have performed a full range of face lifting from a short scar
to full, extended deep plane face and neck lifts.
So in the absence of your comment in your question about your doctor’s management
which, of course, is my first question is what has your doctor been recommending? When
we do a facelift surgery, we see our patients very frequently in the first month or so because
we want to – you know, there are certain times when you have to evaluate after suture
removal and then see how things look in terms of swelling and – as well as monitoring
the incision lines and the healing process. So I’m surprised that there was no comment
about your doctor recommending X, Y, or Z about the earlobe or the incision lines which
I’m going to focus on for this response. To begin with, when you describe that pulling,
you’re basically describing something called the pixie ear. And the pixie ear which is
an interesting term basically describing the way the earlobe is being pulled downward due
to tension. And if the pixie ear is significant or it is something that bothers you then it
will require some type of revision so that you get the natural shape of your ear back.
So that’s one thing that is, kind of, a straightforward issue that I think I’m sure
you would address with your surgeon. As far as the incision lines being red and thick,
well the term that we use for that is called hypertrophic scar. And a hypertrophic scar
is a scar that is becoming thick and red and very often is mistakenly referred to as keloid.
But nonetheless it’s – it represents something called undesirable healing where even with
good closure, a person can develop thickened scars.
So the standard of care is to treat these areas with the combination of a steroid like
Kenalog as well as an anti-metabolite called 5-Fluorouracil. And in addition in our practice
we’ve also been very successful with the use of platelet-rich plasma.
Now these are very basic ways to manage patients who experience these types of issues. Prevention
is always optimal and desirable. In our practice, when we do face lifting surgery, one of the
things that I try to do in the surgical side – you know, when you think of what causes
a pixie ear to form. And very often it’s due to the tension on the skin from aggressive
pulling or the direction on the way the skin is redraped. I will say that you don’t want
to pull too tight. I’m not saying that your surgeon did. But I’m just saying that the
way we do this, pixie ear and deforming it’s just really tend not to happen. In addition
to the style of surgery and the type or level of tension, we also use platelet-rich plasma
and material called extracellular matrix to help heal the incisions and minimize at least
to some degree the chances for undesirable healing.
Even with that, it is still possible. You know, it’s not like your surgeon could have
completely avoided it. But sometimes you can still get thickened scars like yours or hypertrophic
scars with advanced wound healing technology. But the point is, is that you still need management.
And I’m just a little bit concerned that you didn’t mention that the surgeon has been
doing anything at this time. But if they did, you – it wasn’t mentioned in your question.
So again to go back to the issues at least with your right ear. There’s the pixie ear,
the pulling of the earlobe. That can be managed and should be managed at some point when the
time is right. And to hypertrophic scaring which should be managed immediately if you’re
having these symptoms of redness and itching if it hasn’t already been managed.
As far as the numbness is concerned, you know sometimes in cosmetic surgery, there’s a
disruption of sensory nerves. And very commonly, it’s been my experience that people have
more of the numbness in the cheek area that gets smaller and smaller by the time they
see as at three to six months. They’re really not bothered by it.
If the numbness is behind and involving the whole ear, well there’s a nerve called the
greater auricular nerve that could be – it’s what’s called the neurapraxia but – or
it may have been traumatized during surgery. But this is something that it’s better not
to guess but definitely just discuss with your surgeon, have the surgeon assess which
areas in the ear are numb so he can actually determine what nerves may be affected even
though there really is usually not that much you can do at eight months but to observe.
And we’ve also tried using platelet-rich plasma to help patients who have had comparable
problems, who have come to us for second opinions to try to help improve the numbness. You know,
fortunately this type of problem doesn’t happen that often but it can happen. It’s
important that you don’t just assume that your surgeon did something wrong.
With that being said, at least may be you have some guidance now to address questions
to your surgeon regarding your pixie ear, correction, as well as the management of the
hypertrophic scars which – these are things are actionable and can be done something about
as your healing phase of wound remodeling comes to a close.
So I hope that was helpful. I wish you the best of luck. And thank you for your question.

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